Post op big toe fusion

by Gill
(UK)

Hi,

I had a toe fusion on my right big toe 12 weeks ago. I still have pain (and irritation from rubbing on the wound) when walking in shoes, and my toe in it's (normal) position post op is about an inch off the floor, so even when I bend my top joint it won't touch the floor.

Is this normal, as I'm beginning to regret having the op done?

I had osteoarthritis in the toe joint and this was the only option I was given to 'cure the pain'

RESPONSE

Hi Gill,

If you have done much reading on my site, you will find that I am not a big fan of great toe joint fusions. Although they are done quite frequently, there are inherent problems with them.

I wish I knew how old you are as my criteria for doing them is very limited. In general the younger you are, the less inclined I would be to offer that type of procedure. There are certainly alternative procedures that could have been offered.

The problems I have with this type of procedure is partly explained by your complaints as seen in your pictures.

Since the joint is being fused and thus will not allow any movement (and therefore resolve your pain) the big toe has to be angled in a manner relative to the metatarsal bone so that you can actually walk on your foot.

The toe is fused in an elevated position to allow you to "roll" off the great toe when you walk. If the toe was planted on the ground, you would not be able to "roll" off the toe and thus would have difficulty in walking.

If you happen to be relatively young and are athletic, this new position of the toe may or may not impede your ability to be athletic.

The other problem is that any time you fuse a given joint, that automatically puts additional stress on the adjacent joints and can cause pain down the road with those joints. Because the big toe joint is fused and that changes your gait, it creates compensation of the adjacent joints.

If you are an older individual and more sedentary this may not be as big an issue as opposed to being younger and more active.

You mention this procedure was done for osteoarthritis of the big toe joint and that is certainly a criteria for this type of procedure, but there are other procedures that may have been available to you. Naturally I would have to examine you and see x-rays to make any suggestions, but at this point it is water under the bridge.

So, at this point in time, if you can accept the fact that your toe is raised off the ground, you may find as time goes on that you will be able to function fairly well with your toe in its new position. You may have to change the shoes you are accustomed to wearing and will have to look for low heels with a high toe box (room in the front part of the shoe to accommodate the raised toe).

Most surgeons would suggest to you that if the procedure eliminated your pain, then it was a successful procedure.

Marc Mitnick DPM
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